This proposal is aimed at refining psychotherapeutic techniques by focusing on clearly defined target variables and a relatively homogeneous class of patients. It is submitted as a collaborative proposal with Dr. A.T. Beck, University of Pennsylvania. The objectives of this outcome study of therapy in depressed outpatients are: (a) to assess the relative effectiveness of cognitive-behavioral (C/B) therapy, chemotherapy, and the combination treatments for symptom relief in depressed outpatients and (b) to assess the relative effectiveness of C/B, chemotherapy, and the combination treatment for preventing or ameliorating symptomatic relapses in depressed outpatients. The philosophical and historical background of these techniques to influence "phenomenal" field is reviewed. This proposal is an extension of pilot work at the University of Pennsylvania which suggested that C/B therapy is as efficacious as chemotherapy. The combination of chemo- and psychotherapy is anticipated to be more efficacious than either single modality. Thirty adult patients with depressive neurosis will be randomly assigned to each treatment group for twelve weeks. Monthly follow-up is planned for the first 6 months, then quarterly for another 1 1/2 years. Psychotherapeutic techniques will be specified in a "Treatment Manual" (Beck & Rush, 1975) currently under development. Each therapist will be trained prior to and supervised during the study by Drs. Rush and Watkins. Tape recordings and a therapist check list will be used to assure adherence to the treatment program as outlined. Videotapes of evaluation and therapy sessions will be developed for training purposes. Data collection will be consistent with that used in the proposed collaboration with University of Pennsylvania. Serum concentrations will be conducted on all patients receiving chemotherapy to assure response is based on adequate serum levels.